Opinion
712 MDA 2024 J-S45018-24
12-17-2024
IN RE: A.B. APPEAL OF: A.B.
Benjamin D. Kohler, Esq.
NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT O.P. 65.37
Appeal from the Order Entered April 22, 2024 In the Court of Common Pleas of Berks County Civil Division at No(s): 243-2015 MH.
Benjamin D. Kohler, Esq.
BEFORE: OLSON, J., DUBOW, J., and McLAUGHLIN, J.
MEMORANDUM
DUBOW, J.
Appellant, A.B., appeals from the April 22, 2024 order entered in the Berks County Court of Common Pleas affirming the involuntary commitment recommendation of the Mental Health Review Officer ("MHRO"). A.B. challenges the sufficiency of the evidence in support of the involuntary commitment. After careful review, we affirm.
The relevant facts and procedural history are as follows. A.B., who doctors have diagnosed as having unspecified disruptive impulsive control and conduct disorder, unspecified paraphilic disorder, zoophilia, and autism spectrum disorder, has been a resident of Wernersville State Hospital ("Hospital") for more than 10 years. Hospital filed a petition seeking the continued involuntary treatment of A.B. On April 12, 2024, a MHRO held an audio-recorded hearing on the petition pursuant to Section 305 of the Mental Health Procedures Act ("MHPA"), 50 P.S. §§ 7101-7503.
Dr. Michael Lance, A.B.'s psychiatrist, testified that he and A.B.'s care team at Hospital agreed that A.B. should not be released immediately to an unrestricted environment. Dr. Lance testified that A.B.'s care team had been searching for an appropriate out-of-hospital placement for A.B., which would provide A.B. with a structured environment to ensure the safety of A.B. and the community. Dr. Lance also testified that locating such a placement for A.B. has taken more time than expected and, although A.B. understood the situation, it still frustrated A.B. He further testified that A.B. was initially agreeable with the placement plan but had recently expressed his desire to forego placement and preferred to be released into the community. Dr. Lance testified that, notwithstanding A.B.'s preference, he, A.B.'s care team, and the community liaison believed that A.B. needed a step-down transition before being released into the community. Dr. Lance testified that he believed 180 days of further treatment was necessary with the caveat that the care team was actively seeking A.B.'s placement in the community as soon as possible.
Dr. Lance explained that A.B. was participating in Hospital's psycho-sexual/sexual offenders programming, without which, Dr. Lance believed A.B. would be at risk of sexually offending in the community. Dr. Lance testified that A.B. had had some incidents with Hospital staff including, in March 2024, when A.B. became agitated and threatened staff.
Dr. Lance also testified that A.B. takes medication and has not exhibited any signs of self-abuse. He opined that if A.B. were released into the community A.B.'s life would be in danger within 30 days. He explained that A.B. did not have family support and needed full-time care. Dr. Lance admitted that A.B. had made progress in treatment in the preceding six months but emphasized that A.B. still struggled in the program and, although A.B. did not require assistance with activities of daily living, he needed some prompting. Dr. Lance testified that A.B. was not a danger to himself but was a danger to the community. Dr. Lance further opined that Hospital was the least restrictive facility for A.B.
Carrie Emerich, Patient Advocate Supervisor, also testified. She explained that she has known A.B. for approximately three years and meets with A.B. regularly. She testified that A.B. has undergone sex offender testing that indicated that he did not pose a risk of offending adult women or children, only animals. Ms. Emerich testified that A.B. had been making progress with peer relationships and boundaries, but that he had other issues he was continuing to work on. A.B. testified on his own behalf, expressing his dismay with continued treatment. He indicated that he has made progress during his over-20 years of treatment and that he should be discharged as quickly as possible. He testified that, if he were discharged to the community, he would attend outpatient treatment and continue to take his medications as prescribed.
At the conclusion of the hearing the MHRO found that A.B. is severely mentally disabled and in need of continued treatment. The MHRO recommended a combination of inpatient and outpatient treatment to include therapy and medication for a period not to exceed 180 days.
On April 19, 2024, A.B. filed a counselled Petition for Review of Certification for Extended Involuntary Commitment, pursuant to 50 P.S. § 7109. On April 22, 2024, after reviewing the audio tapes of the hearing, the trial court determined that A.B. required further inpatient treatment at Hospital for a period not to exceed 180 days.
This timely appeal followed. Both A.B. and the trial court have complied with Pa.R.A.P. 1925.
A.
A.B. raises one question for our review: "Did [H]ospital fail to present sufficient evidence to support the involuntary commitment of A.B. where the witness's conclusory testimony did not include examples of assaultive or self-abuse behavior within the preceding six (6) months?" A.B.'s Brief at 4. Specifically, A.B. argues that, because Hospital did not present any evidence of "assaultive behavior" by A.B., it did not demonstrate that A.B. is a danger to himself or others thereby necessitating involuntary commitment. Id. at 10-11.
B.
"In reviewing a trial court order for involuntary commitment, we must determine whether there is evidence in the record to justify the court's findings." In re T.T., 875 A.2d 1123, 1126 (Pa. Super. 2005). "Although we must accept the trial court's findings of fact that have support in the record, we are not bound by its legal conclusions from those facts." Id.
The trial court committed A.B. pursuant to Section 7305, which provides that following the expiration of a period of involuntary treatment, an additional period of treatment not exceeding 180 days may be ordered on findings as required by sections 304(a) and (b). See 50 P.S. § 7305(a). Under the MPHA, "in order for an individual to be involuntarily recommitted the petitioner must show by clear and convincing evidence that the individual continues to pose a 'clear and present danger' of harm to himself or to others." Commonwealth v. Helms, 506 A.2d 1384, 1387 (Pa. Super. 1986) (citing 50 P.S. § 7304(a), (f)). A clear and present danger to oneself may be shown by establishing, among other things, that "the person has acted in such manner as to evidence that he would be unable, without care, supervision and the continued assistance of others, to satisfy his need for nourishment, personal or medical care, shelter, or self-protection and safety[.]" 50 P.S. § 7301(b)(2)(i); see also In re S.B., 777 A.2d 454, 457-58 (Pa. Super. 2000).
However, when seeking recommitment or continued commitment of a patient pursuant to Section 7305, a petitioner does not have to prove that the patient committed an overt act establishing danger to self or others within 30 days prior to the hearing as is required by Section 7301. Commonwealth v. Romett, 538 A.2d 1339, 1341-42 (Pa. Super. 1988).
In sum, a Section 7305 petitioner, here, Hospital, requesting an additional period of involuntary treatment for a patient already subject to involuntary treatment, such as Appellant, must prove two factors. First, the petitioner, at a hearing, must "reestablish" the patient's prior conduct, which qualified as a clear and present danger to himself, to others, or both, "in fact occurred[,]" and second, the petitioner must establish the patient's condition continues to evidence a clear and present danger to himself or others. See 50 P.S. §§ 7301(b)(1)-(2), 7304(a)(2), 7305(a); see also S.M., 176 A.3d 927, 936 (Pa. Super 2017); Romett, 538 A.2d at 1341-42. However, "it shall not be necessary to show the reoccurrence of dangerous conduct, either harmful or debilitating, within the past 30 days." 50 P.S. § 7304(a)(2); see also Romett, 538 A.2d at 1341-42.
C.
In explaining its decision to affirm the recommendation of the MHRO, the trial court indicated that it found the testimony of Dr. Lance and Ms. Emerich, as set forth above, "credible and convincing." Trial Ct. Op., 7/10/24, at 9. In particular, the court credited the testimony that A.B. is likely "to reoffend if released to the community without sufficient supports in place." Id. Based on our review of the record, we agree that Hospital met its burden of proving a continued need for Appellant's commitment based on the "clear and present danger" Appellant poses to both the community and, because he has no family support options that could provide the full-time care Appellant requires, to himself. Furthermore, the case law is clear that, contrary to Appellant's argument, Hospital was not required to prove that Appellant exhibited "assaultive or self-abuse behavior" in order to justify his continued commitment. The evidence did establish that, without a proper place to live after discharge, A.B. would be a clear and present danger to himself, and that, therefore, involuntary treatment for a period of up to 180 days to allow for the provision of post-discharge accommodations was required. See In re S.B., 777 A.2d at 459. Accordingly, A.B.'s issue does not merit relief.
Order affirmed.
Judgment Entered.